1. Let’s Leverage the Work you did on Healthy Hearts Northwest for MACRA
April 26, 2017
Jeff Hummel, MD, MPH
Qualis Health
This project is supported by grant number R18HS from the Agency for Healthcare Research & Quality

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3. Goals Is MACRA something I need to pay attention to?
How do the quality metrics from H2N relate to MIPS Quality Measures?
How does the work we are doing for H2N relate to the Clinical Practice Improvement Activities for MACRA?
How can we use this first year of MACRA to best prepare ourselves for the future?
So, what’s your plan? 3

4. Overview of the Quality Payment Program
Qualifying participants develop incentives for better care, smarter spending and healthier people
Consolidates PQRS/Value-Based Payment Modifier/EHR Incentive into a single program
© Qualis Health, 2017

5. Do I need to pay attention to MACRA?
Yes!
> 100 Medicare Part B Patients (office visit) AND billed Medicare > $30,000 for Part B
Similar QPP programs for FQHCs, RHCs, IHS are being developed that are aligned with MACRA
Alternative Payment Model programs require managing the same quality metrics
© Qualis Health, 2017

6. Maybe I’m Exempt from all this
Clinicians new to Medicare are exempt for their first year
Clinicians in Rural Health Clinics and FQHCs are exempt for now, unless they meet the visit and billing eligibility criteria individually
CMS is sending out letters to all Tax ID Numbers informing practice manager about the of exemption status of individual clinicians
© Qualis Health, 2017

7. 6 Quality Measures Required for MIPS
5 can be directly mapped from the H2N work
Statin therapy for preventing CVD
Tobacco screening & cessation
Controlling high blood pressure
Use of ASA for ischemic vascular disease
All or none ischemic vascular disease control
5 more can be readily adapted from H2N work
Tobacco Use: help quitting among adolescents
Screening for HTN and documented f/u
Improvement in blood pressure
Documentation of medications in EHR
Anti-platelet therapy for coronary artery disease
In October of 2016, we will publish an implementation guide – a toolkit – reflecting our experience field-testing the framework. This will include specific tools and resources practices found helpful, for example sample workflows and referral agreements. It will also include impact data and case examples from our field testing sites. The toolkit will be adopted in the Safety Net Medical Home Initiative Resource Library, joining a suite of behavioral health integration tools we published last year. All will be in the public domain and free to all to use and adapt.
© Qualis Health, 2017

8. Improvement Activities
8 major categories of activities
Health equity
Patient engagement
Behavioral health
Care coordination
Increased access to care
Emergency response and preparedness
Patient safety
Population management
Leverage anything you’re passionate about – reporting is based on attestation
© Qualis Health, 2017

9. 4 Improvement Activities Required (2 if rural zip, < 15 providers, or HPSA)
16 to choose from that can be met directly with H2N work
Use evidence-based decision aids to support shared decision-making
Use of decision support and standardized treatment protocols
Tobacco use: Groups and integrated prevention & treatment interventions
Leadership engagement in regular guidance for practice improvement
Integration of patient coaching practices between visits
Improved practices that engage patients pre-visit
Improved practices that disseminate appropriate self-management materials
Implementation of formal QI methods for practice improvement
Implementation of chronic disease self-management support programs
Engagement with QIN-QIO to implement self-management training programs
RHC, HIS, FQHC QI activities
Regular review of practices in place on target population needs
The list goes on….
© Qualis Health, 2017

10. Advancing Care Information
Submit 4 or 5 base score measures depending Certification (2014 or 2015)
Security Risk Analysis
ePrescribing
Patient Access
Send Summary of Care
Request/Accept Summary of Care
Bonus credit for
Reporting to Public Health
Using EHR for Improvement Activities
© Qualis Health, 2017

11. Options for MIPS Participation in 2017
Put your head in the sand and regret it later – not recommended
Submit anything – 1 quality measure, 1 improvement activity, or Advancing Care Information Measure – penalty avoided
Submit 90 days of data in 2017 – may get a positive adjustment and prepare for future
Submit full year of data – may get a positive adjustment and maximize preparation for future

12. So, what do we do? Go to: https://qpp.cms.gov and see for yourself
Talk to your H2N practice coach about leveraging your H2N work in preparation for MIPS
Pick the “no brainer” H2N Quality measures you already have
Supplement those with quality measures easily adapted from H2N
Pick from Clinical Practice Improvement Activities from the list that reflect things you’re already doing or really care about
© Qualis Health, 2017

13. It might look something like this
5 can be directly mapped from H2N data
Statin therapy for preventing CVD
Tobacco screening & cessation P
Controlling high blood pressure P
Use of ASA for ischemic vascular disease P
All or none ischemic vascular disease control
5 more can be readily adapted from H2N work
Tobacco Use: help quitting among adolescents P
Screening for HTN and documented f/u P
Improvement in blood pressure
Documentation of medications in EHR
Anti-platelet therapy for coronary artery disease P
In October of 2016, we will publish an implementation guide – a toolkit – reflecting our experience field-testing the framework. This will include specific tools and resources practices found helpful, for example sample workflows and referral agreements. It will also include impact data and case examples from our field testing sites. The toolkit will be adopted in the Safety Net Medical Home Initiative Resource Library, joining a suite of behavioral health integration tools we published last year. All will be in the public domain and free to all to use and adapt.
© Qualis Health, 2017

14. Pick things you’re already doing
16 to choose from that can be met directly with H2N work
Use evidence-based decision aids to support shared decision-making
Use of decision support and standardized treatment protocols
Tobacco use: Groups and integrated prevention & treatment interventions P
Leadership engagement in regular guidance for practice improvement
Integration of patient coaching practices between visits
Improved practices that engage patients pre-visit
Improved practices that disseminate appropriate self-management materials
Implementation of formal QI methods for practice improvement P
Implementation of chronic disease self-management support programs P
Engagement with QIN-QIO to implement self-management training programs
RHC, HIS, FQHC QI activities
Regular review of practices in place on target population needs P
The list goes on….
© Qualis Health, 2017

15. And Then…?
Develop a plan to submit full year data for 2017, so you get the most out of this year of limited risk
Quality metrics
Clinical practice improvement activities
Advancing care information
Ask your coach to connect you to the regional source for technical assistance that is right for your organization
© Qualis Health, 2017

16. The Big Picture: Quality Payment Programs
It is a move away from reimbursement that rewards only volume, and toward a system that rewards for quality and value
MACRA/MIPS is the first step for groups that are not part of a A-AMP
MIPS is a little like quicksand, i.e. you don’t want to stand there for too long
The long term strategy is to join an A-AMP, but the skills needed be an asset to an A-AMP are the skills needed to survive with MIPS

17. Technical Assistance for QPP
© Qualis Health, 2017

18. Learn More Resources available at: https://qpp.cms.gov
Jeff Hummel, MD, MPH
© Qualis Health, 2017